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Biomarkers in Persistent AF and Heart Failure: Impact of Catheter Ablation Compared with Rate Control
David G Jones1,2, Shouvik K Haldar1,2, Jacqueline Donovan3
1Department of Cardiac Electrophysiology, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, Imperial College London, London, UK.
Insights
Catheter ablation significantly reduced MR-proANP in heart failure patients with persistent atrial fibrillation (AF), improving cardiac function and quality of life compared to rate control.
Area of Science:
- Cardiology
- Biomarker Research
- Heart Failure Management
Background:
- Persistent atrial fibrillation (AF) complicates heart failure (HF) management.
- Investigating cardiac and inflammatory biomarkers is crucial for understanding treatment effects in HF with persistent AF.
Purpose of the Study:
- To compare the effects of catheter ablation versus rate control on cardiac and inflammatory biomarkers.
- To assess the impact of these strategies on physiological and symptomatic outcomes in HF patients with persistent AF.
Main Methods:
- Recruitment from the ARC-HF trial comparing catheter ablation and rate control for persistent AF in HF.
- Assay of B-type natriuretic peptide (BNP), MR-proANP, apelin, and IL-6 at baseline and 12 months.
- Primary endpoint: change from baseline in biomarkers at 12 months.
Main Results:
- Catheter ablation led to a significant reduction in MR-proANP compared to rate control (P=0.028).
- BNP showed a trend towards reduction with ablation (P=0.051); apelin and IL-6 showed no significant differences.
- Biomarker changes correlated with improvements in peak VO2, ejection fraction, and quality of life.
Conclusions:
- Catheter ablation, unlike rate control, significantly reduced MR-proANP in HF patients with persistent AF.
- Ablation may promote beneficial cardiac remodeling, independent of inflammatory changes.
- These findings suggest potential prognostic benefits of rhythm control via ablation, warranting further investigation.
Background:
To investigate the effects of catheter ablation and rate control strategies on cardiac and inflammatory biomarkers in patients with heart failure and persistent atrial fibrillation (AF).
Methods:
Patients were recruited from the ARC-HF trial (catheter Ablation vs Rate Control for management of persistent AF in Heart Failure, NCT00878384), which compared ablation with rate control for persistent AF in heart failure. B-type natriuretic peptide (BNP), midregional proatrial natriuretic peptide (MR-proANP), apelin, and interleukin-6 (IL-6) were assayed at baseline, 3 months, 6 months, and 12 months. The primary end point, analyzed per-protocol, was changed from baseline at 12 months.
Results:
Of 52 recruited patients, 24 ablation and 25 rate control subjects were followed to 12 months. After 1.2 ± 0.5 procedures, sinus rhythm was present in 22 (92%) ablation patients; under rate control, rate criteria were achieved in 23 (96%) of 24 patients remaining in AF. At 12 months, MR-proANP fell significantly in the ablation arm (-106.0 pmol/L, interquartile range [IQR] -228.2 to -60.6) compared with rate control (-28.7 pmol/L, IQR -69 to +9.5, P = 0.028). BNP showed a similar trend toward reduction (P = 0.051), with no significant difference in apelin (P = 0.13) or IL-6 (P = 0.68). Changes in MR-proANP and BNP correlated with peak VO2 and ejection fraction, and MR-proANP additionally with quality-of-life score.
Conclusions:
Catheter ablation, compared with rate control, in patients with heart failure and persistent AF was associated with significant reduction in MR-proANP, which correlated with physiological and symptomatic improvement. Ablation-based rhythm control may induce beneficial cardiac remodeling, unrelated to changes in inflammatory state. This may have prognostic implications, which require confirmation by event end point studies.
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